Wednesday, September 19, 2012

Where Are the Candidates on Medicaid?

Since the selection of Congressman
Paul Ryan (R-WI) as the 2012 Vice Presidential candidate for the
Republican Party, there has been an increasing focus on how each party
would tackle health care reform under their Administration. Maybe this
is because prior to being tapped as the GOP VP candidate, Ryan served as
the House Budget Committee Chairman and in that capacity proposed
drastic cuts to entitlement programs including Medicare and Medicaid. Or
perhaps it is because the Supreme Court recently upheld most of the key
elements of the Affordable Care Act (ACA). Quite possibly, it could be
because in 2006, Governor Romney signed a health care reform law in
Massachusetts that many cite as the blueprint for the ACA. Whatever the
case may be, it's apparent that there is clear and growing interest in
where the candidates stand on health care.

For the most part, the coverage has been focused on the candidates'
positions on Medicare, which is not surprising knowing that both parties
want to appeal to the elderly, who are known to be the most consistent
voting demographic. However, little to no attention has been given to
the candidates' positions on Medicaid, even though the elderly who may
reside in nursing homes, or otherwise need long-term health care account
for a significant portion of Medicaid expenditures. More importantly,
children, who make up over half of the Medicaid beneficiaries, but
effectively no voting power, and the remaining beneficiaries (the poor
and disabled) tend to be among those least likely to be engaged in the
election process. The outcome of the November elections will
significantly impact the future of the Medicaid program and the coverage
provided to current and prospective beneficiaries and therefore it's
important to understand where the candidates stand on this critical
safety net program.
The passage of the ACA in 2010 and the Children's Health Insurance
Reauthorization the year prior provided President Obama the opportunity
to make a defining statement about his vision for providing health care
coverage to poor children and their families as well as other vulnerable
populations, the disabled and the elderly, that tend to be Medicaid
beneficiaries. Under these reforms Medicaid coverage has been expanded,
strengthened, and protected for the future years. Additionally, under
ACA and CHIP the number of uninsured has decreased and former foster
youth are now eligible for Medicaid coverage until the age of 26. In his
most recent budget proposal, President Obama highlighted his
Administration's opposition to House Republican efforts to turn Medicaid
into a block grant, which would cap funding to what is currently an
open-ended entitlement. As a child welfare advocate, I also strongly
oppose a Medicaid block grant because setting a cap on funding could
potentially lead to enrollment caps, reduced services, and out of pocket
expenses for children and families who are enrolled in Medicaid on the
basis of not being able to afford health care coverage in the private
market. Instead of a block grant, the Obama Administration has proposed a
blended match to replace the current patchwork of formulas that states
currently receive.
In 2006, when Romney was Governor of Massachusetts, he signed a
health care insurance reform law which expanded the state's Medicaid
program (MassHealth) to tens of thousands of children in families in the
commonwealth. While Governor Romney has offered very little specifics
around his Medicaid proposal, he has made one thing clear: as President
he would repeal the ACA, thereby jeopardizing coverage for current
beneficiaries but also eliminating coverage for the tens of millions of
Americans expected to gain access to Medicaid under the ACA. According
to his website, Romney has endorsed his running mate's plan to block
grant Medicaid and offer more flexibility to states as they run their
respective programs. He also supports placing limits on federal
standards and requirements for Medicaid coverage, thereby restricting
the federal government's ability to determine what services states must
provide under their Medicaid programs.
Ultimately, the decision will be up to the American voters as they
head to the polls in November. In the coming weeks, I want you to ponder
a particularly important and poignant question: what vision for
America's most vulnerable are you going to support?
One that ensures vulnerable children and families, the disabled, and
the most needy have a strong safety net that meets their most pressing
needs.
Or one that makes deep cuts to safety net programs for
the sake of reducing the deficit, despite the fact that those who rely
on these very programs are increasingly in need.